Provider Demographics
NPI:1619324845
Name:HYMAN, MICHELLE (LPN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HYMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:MICHELLE
Other - Last Name:HYMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:4099 MCEWEN RD STE 250
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5030
Mailing Address - Country:US
Mailing Address - Phone:214-754-8700
Mailing Address - Fax:
Practice Address - Street 1:4099 MCEWEN RD STE 250
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244-5030
Practice Address - Country:US
Practice Address - Phone:214-754-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163653164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163653OtherLPN LICENSE